G9433 HCPCS Reimbursement & Policy Benchmarks

HCPCS Level II code G9433 documents that a patient was deceased, a permanent nursing home resident, or received hospice or palliative care at any time during the measurement period. This status-based code is important for quality measurement, risk adjustment, and administrative reporting for populations receiving end-of-life or long-term care services. Nationally, accurate capture of these statuses affects performance metrics, quality reporting, and appropriate attribution of care.

Key payers included in this coverage set are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the code's clinical and administrative context, typical sites of service, and guidance on where this code commonly appears in measurement workflows. The publication outlines benchmark considerations, reporting use cases, and recent policy developments affecting status-based coding and quality measures.

This summary provides the clinical context for G9433, explains common use in measurement and reporting for long-term care and hospice populations, and highlights implications for national quality programs and payer reporting. Data not available in the input for modifiers, associated taxonomies, ICD-10 mappings, related codes, and service-line specifics are noted where relevant in the full publication.

Billing Code Overview

HCPCS Level II code G9433 indicates death, permanent nursing home resident, or receiving hospice or palliative care at any time during the measurement period. This code is used to document that a patient met one of these status-based criteria during the reporting timeframe and is typically applied in quality measurement, reporting, or administrative records related to end-of-life or long-term care status.

Service type: Status/Administrative encounter related to patient residence or care setting

Typical site of service: Long-term care facility (nursing home), hospice facility, or palliative care setting

Data not available in the input.

Clinical Context

A typical patient is an elderly resident of a long-term care facility with advanced chronic illness who dies during the measurement period, or a patient who was enrolled in hospice or receiving palliative care and dies while under those services. Clinical workflow begins with the care team documenting the patient’s status change to hospice enrollment or palliative care, or noting death in the medical record. The facility or hospice provider confirms dates of hospice admission and/or date of death, updates the electronic health record and billing systems, and applies the appropriate billing code G9433 for quality measurement and reporting to reflect that the patient was a permanent nursing home resident or received hospice or palliative care at any time during the measurement period. Relevant documentation includes hospice hospice certification/discharge forms, death certificate or facility death note, advance directive or POLST when available, and care transition notes between nursing facility and hospice. Administrative staff reconcile the claim with payer-specific requirements (for example, Medicare hospice benefit enrollment) and submit data for performance measurement and quality reporting.

Coding Specifications

Modifier	Description	When to Use
`GT`	Via interactive audio and video telecommunications (telehealth)	Use when a related service was furnished via real-time telehealth (if applicable for ancillary services during hospice care)

Taxonomy Code	Specialty	Notes
`251100000X`	Geriatric Medicine	Often oversees care coordination for nursing home residents and hospice transition
`372500000X`	Palliative Care Medicine	Primary specialty for patients receiving palliative services
`261QM0800X`	Hospice and Palliative Medicine	Specialists who manage hospice eligibility and comfort-focused care
`207Q00000X`	Family Medicine	Commonly provides primary care and end-of-life care in nursing facilities
`207L00000X`	Internal Medicine	Hospital-based or clinic-based physicians who coordinate hospice referrals

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Z99.89`	Dependence on other enabling machines and devices, not elsewhere classified	Indicates residents requiring ongoing support devices common in long-term care
`Z51.5`	Encounter for palliative care	Directly denotes patients receiving palliative services during the measurement period
`Z51.0`	Encounter for antineoplastic radiation therapy	May be present for patients who transitioned to hospice after cancer treatment
`I50.9`	Heart failure, unspecified	Common advanced chronic illness leading to hospice enrollment
`C80.1`	Malignant neoplasm without specification of site, metastatic	Advanced cancer frequently associated with hospice care
`J96.00`	Acute respiratory failure, unspecified whether with hypoxia or hypercapnia	Possible terminal event leading to death in nursing facility residents
`R99`	Ill-defined and unknown cause of mortality	Used when death is documented but specific cause is pending or unknown
`Z99.89`	Repeated: Dependence on other enabling machines and devices	(Duplicate row removed in coding systems; included once in clinical practice)

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99304`	Initial nursing facility care, per day, for the evaluation and management of a new or established patient, typically 45 minutes	Used for comprehensive E/M when a patient is newly admitted to a skilled nursing facility or when documenting transition to hospice care
`99306`	Initial nursing facility care, per day, for the evaluation and management of a new or established patient, typically 70 minutes	Used for more complex initial evaluations of nursing facility residents entering hospice or palliative care
`99307`	Subsequent nursing facility care, per day, for the evaluation and management of a patient, typically 10 minutes	Used for routine follow-up visits for residents receiving hospice or palliative care
`99308`	Subsequent nursing facility care, per day, typically 15 minutes	Used for longer follow-up visits during hospice care
`99497`	Advance care planning including the explanation and discussion of advance directives, first 30 minutes	Performed commonly when patients or surrogates elect hospice or palliative care and document goals of care
`99498`	Advance care planning, each additional 30 minutes	Used when longer discussion of goals of care and POLST is documented

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Summary & Overview

HCPCS G9433: Death or Permanent Nursing Home or Hospice/Palliative Care